The primary method that doctors and hospitals use to track patient health history is failing to capture critical behavior and mental health data.
A study released in April by the Harvard Pilgrim Health Care Institute compared the electronic health records (EHRs) to the insurance claims of some 5,500 patients.
The focus of the study was on patients with depression or bipolar disorder who received care from Harvard Vanguard Medical Associates, part of Atrius Health.
The research is a collaborative effort between Harvard Pilgrim Health Care and Harvard Medical School’s Department of Population Medicine.
Physicians and medical institutions use EHRs to record checkups, lab results, ER visits, and other crucial health information.
Researchers say the EHRs analyzed in the report showed significant gaps in behavioral and mental health patient records.
Experts who spoke to Healthline about the study say the findings reveal as much about the fractured nature of healthcare IT technology as it does the fractured approach to healthcare in the United States.
“The core issue is that we don’t have an integrated healthcare system,” Nigam H. Shah, M.B.B.S., Ph.D., associate professor of medicine (biomedical informatics) at Stanford University and assistant director of the Center for Biomedical Informatics Research, told Healthline. “Everyone has an EHR, but the U.S. healthcare system is still fragmented.”
Not on the Books
According to the report, nearly one-fourth of depression and bipolar diagnoses were not recorded within the EHR system used by Harvard Vanguard Medical Associates.
More than half of all behavioral visits were not listed.
Nearly 90 percent of acute psychiatric services at hospitals were not entered in EHRs.
Overall, the rates remained the same for outpatient and inpatient services.
The study’s principal investigator and senior author called the findings detrimental toward the federal efforts to promote the use of EHR systems nationwide.
“Our national policy for investment in EHRs needs to be re-examined to surmount the fragmentation that currently exists in U.S. healthcare,” Stephen B. Soumerai, Sc.D., the director of the Drug Policy Research Group at the Harvard Pilgrim Health Care Institute, told Healthline.
EHRs have been around since the 1980s, but back then the technology was used as more of a means for taking notes and documenting lab results.
It wasn’t until 2009, when the U.S. government rolled out what are called “Meaningful Use” rules, hospitals and medical practices truly started to adopt the technology.
“There are three phases [of meaningful use adoption],” Dr. Carolyn Jasik, assistant medical director for Health IT and assistant professor of pediatrics at the University of California, San Francisco (UCSF), told Healthline. “And the rules are different at each stage.”
The rules set specific objectives that doctors and hospitals must achieve in order to qualify for the Centers for Medicare and Medicaid Services Incentive Programs.
If institutions follow the rollout, the money will come in the form of reimbursements from the federal government.
At the heart of “Meaningful Use,” are four key components: open access for patients, safer prescription and medicine distribution, simplified compliance and billing, and the collection of big data for long-term studies and research, according to Jasik.
“It’s a big deal,” she said.
Why is Data Missing?
Today, close to three-fourths of all U.S. hospitals use “basic” EHR systems.
Of those, about 97 percent use a “certified” EHR system, which means it meets “the technology capability, functionality, and security requirements adopted by the U.S. Department of Health and Human Services,” according to the HealthIT.gov website.
So with such a highly successful rate of adoption, why are big chunks of mental health data missing?
Experts point to competition.
Currently, about a dozen different software companies provide the bulk of EHR systems in the U.S., according to Jasik.
Some systems “talk” to each other due to previously agreed upon partnerships. Others don’t.
A good example is a medical teaching hospital. They may have multiple EHR systems in place — for the hospital, the psych ward, and the clinics on site — that don’t necessarily share patient information.
It seems like common sense that these systems should communicate, but IT purchasing decisions really come down to the financial resources available to each department.
“Patients are part of that decision, but they aren’t the entire reason,” Jasik said.
Doctors Bear the Burden
While it’s easy to blame technology for the fractured state of EHRs, Shah explains that the report also underscores the challenges that primary care physicians, in particular, face when practicing modern medicine.
They are the ones responsible for gathering the health history of patients. A problematic knee is shared easily at regular checkups, but mental health concerns, he noted, still carry social shame in many populations.
“The stigma is a double whammy,” he said. “It’s a worse case quantification of the problem.”
How people tend to seek out mental health care, Jasik added, also feeds the problem. Usually they look for therapists covered under their insurance plans or they have reliable personal references.
“It’s really about the unnecessary divide between traditional medicine and mental healthcare,” she said. “People tend to get their mental healthcare in the community.”
To get paid, these therapists have to submit reimbursements with the correct mental health codes.
However, those codes will never make it to the EHR that the primary care physician uses — unless the patient brings it up, or the doctor asks.
“Insurance companies know everything,” she said. “They pay the bills for health and mental visits.”
According to Jasik, the most proactive way to close the gap on mental health information is for the medical industry to embrace a comprehensive care model. Kaiser Permanente is a good example.
This is where a team of physicians practices as one.
Jasik currently works at a pediatric eating disorder clinic at UCSF. She said psychiatrists, dieticians, and other medical experts work together, ready to respond should a patient need specific counseling or care.
Plus they are using the same EHR system, ensuring that both medical and mental health information is entered, tracked, and analyzed for future visits.
“The solution,” she said, “is merging that care.”